Abstract Details

Title Acute Symptomatic Seizures Secondary to Autoimmune Encephalitis

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 010

Objective

Identify factors associated with the development of seizures and whether, in addition to immunotherapy, the choice of antiseizure medication is associated with decreased time to electro-clinical seizure freedom in the acute phase of autoimmune encephalitis.

Background Seizures are common in patients with AE, and guidelines suggest should be treated with a combination of immunotherapy and antiseizure medications.

Design/Methods

The electronic medical records of patients with probable or definite autoimmune encephalitis (2010-2021) were retrospectively analyzed, and patients with either clinical or electrographic seizures were classified as having acute symptomatic seizures secondary to autoimmune encephalitis. Electrographic and clinical features associated with the development of acute symptomatic seizures secondary to AE were incorporated into a logistic regression model using a stepwise forward selection model. For patients with acute seizures, a Cox hazard ratio mixed-effect model with time to electro-clinical seizure freedom as the event of interest was performed.

Results Among the 102 patients with acute autoimmune encephalitis included, 74 patients (73%) had acute symptomatic seizures: 34 patients with clinical-only seizures, 2 with electrographic-only seizures, and 38 had a combination of clinical and electrographic seizures. Patients with focal slowing, interictal discharges, and periodic discharges were more likely to have electrographic seizures (especially when extra-temporal and with superimposed fast activity), and patients with cell-surface antibodies were more likely to develop either clinical or electrographic seizures after (adjusted odds ratio= 5.00; p=0.01). Patients with LGI1 encephalitis who received sodium channel blockers achieved electro-clinical seizure freedom more rapidly (p<0.05) compared with those on other agents.

Conclusions

Acute symptomatic seizures are common in patients with autoimmune encephalitis, especially in those with cell-surface autoantibodies. Anti-seizure medications plays a complementary role to immunotherapy to achieving earlier electro-clinical seizure freedom, especially in patients with LGI1 encephalitis.

Authors/Disclosures
Julien Hebert, MD (Toronto Western Hospital (University Health Network)) PRESENTER	Dr. Hebert has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Paladin Labs. Dr. Hebert has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Gowling WLG. The institution of Dr. Hebert has received research support from Praxis Precision Medicine.
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons)	Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio.
Hyunmi Choi, MD (Columbia University Medical Center)	Dr. Choi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsy Research by Elsevier. The institution of Dr. Choi has received research support from National Institute of Aging.
Hai Ethan Hoang, MD (Weill Cornell Medicine)	Dr. Hoang has nothing to disclose.
Lucy Jia, MD	Ms. Jia has nothing to disclose.
Carla Kim	Carla Kim has nothing to disclose.
John Budrow, MD	Dr. Budrow has nothing to disclose.
Jieru Egeria Lin, MD, PhD	Dr. Lin has nothing to disclose.
Pallavi Juneja, MD	Dr. Juneja has nothing to disclose.
Donald Langan, Jr., MD (New York Presbyterian - Weill Cornell)	Dr. Langan has nothing to disclose.
William T. Harris II, MD (Helmsley Medical Tower)	Dr. Harris has stock in Eli Lilly and Co. Dr. Harris has stock in Glaxo Smith Kline.

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